The female patient, reported on the December 7 issue 45 of World J Gastroenterology, presented a rare case, with symptoms consistent with hyperadrenocorticism and hypercatecholaminism, and also had a Cushingoid appearance.
The serum cortisol, dopamine and noradrenalin levels were elevated. Computed tomography detected a left adrenal mass measuring 3.5 cm -- 3.0 cm in diameter. Metaiodobenzylguanidine scintigraphy was negative. Unexpectedly, the serum carcinoembryonic antigen (CEA) level was elevated. Fluorodeoxyglucose positron emission tomography showed increased uptake in the adrenal tumor only, with a maximum standardized uptake value of 2.8. Selective venography and blood sampling revealed the concentrations of cortisol, catecholamines and carcinoembryonic antigen were significantly elevated in the drainage vein of the tumor. A diagnosis of carcinoembryonic antigen-producing benign adenoma was made. After preoperative management, Dr. Hori's group performed a combined lateral and anterior transperitoneal laparoscopic adrenectomy. The patient's vital signs remained stable during surgery. Histopathological examination revealed a benign adenoma. The cortisol, catecholamine and carcinoembryonic antigen levels normalized immediately after surgery.
Laparoscopic adrenectomy (LA) was first performed in 1992, and this safe and effective treatment is now used worldwide for the management of functioning and non-functioning adrenal tumors. The minimal skin incisions provide a sufficient surgical field, anastomosis and reconstruction are not required, hemostasis can be achieved using laparoscopic devices, and the resected tumor can be removed through the small skin incision. Many previous documents focused on LA have already described the advantages and shortcomings of the transperitoneal and retroperitoneal approaches. There are two transperitoneal approaches, lateral and anterior. Especially in left adrenal tumors and cases with more retroperitoneal fat, Hori et al. suggested that the combined lateral and anterior transperitoneal LA has the advantage of providing a sufficient surgical field and anatomical orientation in a timely manner, and that the combined approach allowed easy and early ligation of the drainage vein which was the source of the catecholamines.
When surgeons believe that the left adrenal tumor might be producing a large amount of CEA, Dr. Hori and colleagues recommend that investigators perform selective venography and direct blood sampling of the drainage vein of the tumor for verification, as this method was useful for detecting the source of CEA.